Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by antibody-mediated platelet destruction. Despite initial response to corticosteroids, most adults relapse during steroid taper, and splenectomy is the treatment of choice for these patients. Those whom splenectomy fails to cure present a therapeutic challenge. Subsequent management usually involves some form of chronic immune suppression, which has serious side effects and long-term morbidity. Rituximab, a recently-approved anti-CD20 chimeric monoclonal antibody, has shown efficacy in preliminary studies. We report the cases of 3 patients with refractory ITP who achieved acceptable platelet counts after treatment with rituximab.